Challenges in the Prevention, Diagnosis, and Treatment of Malaria in Human Immunodeficiency Virus–Infected Adults in Sub-Saharan Africa

Abstract

Background: Many countries in sub-Saharan Africa currently report high prevalences of both human immunodeficiency virus (HIV) and Plasmodium falciparum malaria. The likelihood of HIV-malaria coinfection may affect clinical management of patients. The extent to which standard clinical guidelines address HIV-malaria coinfection is unclear. Methods:We reviewed standard World Health Organization and other guidelines for diagnosis and treatment of malaria and/or HIV-related illness. We also searched PubMed (1990 to present) for literature on HIVmalaria interactions and treatment of coinfection. We restricted our review to the situation of the nonpregnant HIV-infected adult.Results: We found only 6 articles describing the clinical presentation of HIV-malaria coinfection in adults. We also identified 10 clinical or laboratory syndromes that are shared by malaria and AIDS-related conditions and that might provoke diagnostic confusion. We identified 12 antimalarial medications whose coadministration with antiretrovirals is known or suspected to result in drugdrug interactions or overlapping toxicities.Conclusions: Substantial overlap in the clinical and laboratory characteristics of malaria and HIV-related syndromes generates potential difficulties in AIDS staging and in diagnosis and management of patients at risk for coinfection. Significant drug-drug interactions and overlapping drug toxicity profiles further complicate concurrent management of malaria and HIV. Standard clinical guidelines do not reflect the full complexity of the interactions and overlaps between the 2 infections. Clinicians who manage HIV-infected patients in malariaaffected regions should systematically consider malaria when evaluating patients with a broad spectrum of symptoms. Further research is urgently needed to define best practices for prevention, diagnosis, and management of HIV-malaria coinfection in this region.

Enhanced T cell activation in Plasmodium falciparum malaria-infected human immunodeficiency virus-1 patients from Mozambique

“…These facts highlight the importance of assessing any malaria-induced disturbances in the laboratory prior to deciding how to manage HIV positive individuals. This approach can avoid the misdiagnosis of ARV failure or even the premature initiation of therapy (Brentlinger et al 2007). Unfortunately, access to ARV is not yet universal, either in Mz (INSIDA 2009) or in other African countries, whereas antimalarials drugs are currently accessible for the population.…”

“…CD4 + T cell counts have been implicated in Plasmodium control (Brentlinger et al 2007, Idemyor 2007, because these cells are negatively correlated with PD (Withworth et al 2000. However, we did not observe any association between these parameters, perhaps because of the study sample size.…”

Coinfection HIV and Malaria in Department of Paediatrics of the University Hospital Souro Sanou

“…Co infection does not require changing the therapeutic protocol compared to the treatment of uncomplicated malaria and severe malaria, which is shared by Brentlinger [34], although for some authors a delay was found in the clearance of parasite in patients infected with HIV and treated with artemisinin, suggesting a metabolic disorder of antimalarials according to the immunological profile of the host [35].…”

The Effect of HIV Infection on the Risk, Frequency, and Intensity of Plasmodium falciparum Parasitemia in Primigravid and Multigravid Women in Malawi

“…6 Human immunodeficiency virus (HIV)-infected persons are at increased risk of clinical malaria compared with HIVuninfected persons and have a poorer response to antimalarial drugs in some studies. [7][8][9][10] The HIV increases the risk of maternal parasitemia during pregnancy 11 and of congenital malaria in the infant. 12 Although congenital malaria is uncommon, it has been associated with poor maternal antibody response to malaria antigens in HIV-positive women.…”